Comparison of Analgesic Efficacy of Dexamethasone versus Tramadol in Combination with Ropivacaine in Caudal Anesthesia for Children Undergoing Lower Abdominal Surgeries

Abstract

Background: Caudal anesthesia has emerged as a reliable and effective anesthetic technique in the pediatric age group. However, the limited duration of action of the local anesthetic drugs proves to one of the major hindrances in the complete utilization of caudal block as an effective analgesic technique. To overcome this shortcoming, adjuvant drugs were introduced into clinical practice.

Aim: Our aim was to determine which of the two drugs - dexamethasone and tramadol - serves as a better adjuvant for caudal analgesia in pediatric patients.

Settings and design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anesthesiologist (ASA) physical status I and II pediatric patients posted for lower abdominal surgeries.

Materials and methods: Ninety ASA physical status I and II children aged 5-12 years posted for lower abdominal surgeries were chosen. They were randomly divided into three groups - Group R received 0.5 ml.kg^-1 of 0.2% ropivacaine plus 0.9% normal saline; Group T received 0.5 ml.kg^-1 of 0.2% ropivacaine plus 2 mg.kg^-1 tramadol; and Group D received 0.5 ml.kg^-1 of 0.2% ropivacaine plus 0.1 mg.kg^-1 dexamethasone. Postoperative pain was assessed using a modified objective pain score and time to first rescue analgesia (duration of sensory block) was recorded. Postoperative sedation and any other postoperative adverse effects were noted.

Statistical analysis: Student's independent t-test was employed for comparing continuous variables and Chi-square test for categorical variables. Kruskal-Wallis test was used for postoperative pain and sedation score data.

Results: The duration of sensory block was significantly longer with dexamethasone than tramadol. No significant postoperative sedation or any other adverse effect was noted in any patient.

Conclusion: Dexamethasone is superior to tramadol as an adjuvant to ropivacaine for pediatric lower abdominal surgeries.

Keywords: Caudal anesthesia; dexamethasone; pediatric surgeries; ropivacaine; tramadol.